Gastroenterology Flashcards
(39 cards)
HBsAg pos
Anti-HBc pos
IgM Anti-HBcore Negative
Anti-HBs Negative
What is this?
Chronic hepatitis B
HBsAg neg
Anti-HBc neg
Anti-HBs pos
What is this?
Vaccinated
HBsAg neg
Anti-HBc pos
Anti-HBs pos
What is this
Resolved HepB infection
HBsAg pos
Anti-HBc pos
IgM Anti-HBcore pos
Anti-HBs Negative
What is this?
Acute Hep B infection
Stages of Chronic Hepatitis B infection (just the stages)
Phase 1: Immune tolerance
Phase 2: Immune clearance
Phase 3: Immune control
Phase 4: Immune escape
Stages of Chronic Hepatitis B infection (Description of stages- tests)
Immune tolerance
- Viral load HIGH
- LFTs Normal
- HBeAg pos
–> monitor 6-12 monthly
Immune clearance
- Viral load HIGH
- LFTs deranged
- HBeAg pos
–> refer for treatment
Immune control
- Low viral load
- LFTs normal
- Anti- HBeAg
–> monitor 6-12 monthly
Immune escape
- Viral load HIGH
- LFTS deranged
- Anti- HBeAg
—> refer for treatment
HCC surveillance (indications, and what)
- LIVER US +/- AFP
Chronic heb B PLUS
- Cirrhosis
- Without cirrhosis but:
African >20
ASTI >50
Asian men >40
Asian women >50
Family hx HCC
Chronic Hep B monitoring
Viral load
Iron supplementation counselling
- Constipation
- GI upset: nausea
- 3 months then retest
- Take on empty stomach
- Dark stools
- Take with vitamin C
Chronic Heb B management (on antivirals)
- Quarterly viral load
- annual HbsAg and Anti-Hbs (for seroconversion- therefore cessation of treatment)
- HCC surveillance
- Condoms with new partners
- etOH
Aspirin advice for bowel cancer prevention
100mg daily for at least 2.5 years (from 50-70 years)
Immediate emergency management of haematemesis (shock symptoms)
- Call ambulance for urgent transfer to tertiary centre
- Insert 2x large bore IV cannulae in cubital fossa
- Normal saline 0.9% bolus (500ml-1000ml)
- IV pantoprazole 40-80mg stat ** don’t forget
- Keep NBM
- Monitor vitals
Clinical signs for haemachromatosis
- Bronzed skin
- Joint swelling/tenderness
Then think liver disease signs
- Hepatomegaly, spider naevi
Then think heart failure
- Peripheral pitting oedema, elevated JVP
General causes for LFT derrangement (young, without cancer risk factors)
- Alcoholic hepatits/fatty liver diseae
- Hepatic steatosis
- Hepatitis A,B,C
- Autoimmune hepatitis
- Haemochromatosis
- Rare: Wilson’s, alpha 1 anti-trypsin deficiency
Non alcoholic fatty liver disease- new name
MAFLD
Metabolic (dysfunction) associated fatty liver disease
Management of MALFD
- Weight loss 7-10% (referral to AEP)
- Mediterranean diet
- Atorvastatin 10mg
- No alchohol
- arrange Fibroscan to assess for fibrosis
- Discuss HepA&B vaccination
- Aggressive management of CVD risk factors
Screening for HCC in cirrhosis
AFP (alphafetoprotein) every 6 months
Liver US every 6 months
Differentials for dyspepsia
- GORD
- H.pylori gastritis
- PUD
- Medication induced Gastritis
- EtOH induced gastritis
- Functional dyspepsia
- Biliary colic
- Gastric or oesophageal ca
- pancreatitis
- Gastroparesis
PUD management
(Plus indications for prolonged acid suppression & repeat gastroscopy)
- Pantoprazole 40mg**
- Smoking cessation
- Consider repeat gastroscopy 8-12 weeks to check resolution ***
**
Giant ulcer >2cm
Other issue needing ongoing NSAIDs (eg stroke prevention)
>2 in a year
Persistent on repeat endoscopy
Giant >2cm
persistent symptoms despite PPI
evidence of bleeding
features of malignancy
LFTs: ALP >200 and ALP 3x ALT
- Cholestasis or HC damage
Cholestasis
LFTs: ALT >200 and ALT 3x ALP
- Cholestasis or HC damage
HC Damage
Causes of Cholestasis picture on bloods
1) Pregnancy
2) Biliary obstruction:
- Gallstone
- Head of pancreas carcinoma
- Cholangiocarcinoma
3) Drugs: erythromycin, oestrogen, flucloxcillin
4) Primary biliary cirrhosis
5) Primary sclerosing cholangitis
> 60 & weight loss
PLUS and
- Diarrhoea
- Vomiting
- Abdominal pain
- Change in bowels,
- New onset diabetes
a) What are you concerned about?
b) what test
Pancreatic carcinoma
CT abdomen
Traveller’s Diarrhoea Pharmacology management
Azithromycin 1g single dose
